Health Economists Ignore Working Class Realities

Health Economists Ignore Working Class Realities

Ah, the Affordable Care Act. We’ve all been inundated with the stories about the rocky launch of Obamacare's Healthcare.gov website, the policy cancellations that drop people from coverage rather than meet minimum standards required by the ACA, and other issues like the one I have faced with a deeply flawed subsidy/tax credit application process that required a lengthy and intrusive Medicaid application.

Some of these issues were predictable and preventable; others were not.

But one thing I keep hearing both political parties lament about is the lower than expected enrollments since the October 1 launch. Republicans want to say that reflects the American public’s dislike of Obamacare; the Democrats want to point to the newness of the program and the computer glitches as problematic. I want to give the health economists and the politicos who expected much higher numbers a little working class economics lesson.

Enrolling in a new health plan on the ACA/Obamacare exchange requires payment of the premium at the time of enrollment. Many working class families live paycheck to paycheck or they are in the hole financially. They make too much to qualify for Medicaid but too little to make an additional insurance payment right now that can be put off until the last moment. To be even clearer: working class people like me do not have hundreds of extra dollars in the bank to make that new premium payment in advance of when it will take effect. For many, like me, we are already paying a huge medical insurance premium (mine is $875 every month for individual COBRA/Aetna policy), and we’re in the hole trying to make that happen.

Hence, I will look at what’s available to me on the exchange – Connect for Health Colorado – but I will wait to actually enroll until I have the money to pay the premium. Will that be tomorrow or December 1 or right before Christmas on December 15th (the last day to pay for the January 1st coverage)? I do not know. I just got the Medicaid denial this week after waiting 36 days. That wait prevent me from going forward to shop for coverage. So, that’s a working class reality.

And while I am at it on this working class health economics lesson: Who was the brain-child who decided the first payments would be due right in the middle of the holiday season? Should parents short their holiday spending this year and just tell the kids, “Sorry, I have to pay two insurance premiums this month”? Should they be forced to pawn things or borrow from family to stay afloat? Come on. Please—those of you in charge in this country—please at least actually ask someone in the working class to comment on your efforts before assuming whatever you work up will actually be “affordable.”

I suspect many, many Americans like me will wait until the last moment to enroll for new coverage not because we want to do that but because we literally, financially speaking, have no choice. That’s working class health economics 101. And while they’re at it, why in the world didn’t Congress and the president consider and cost out a true money- saver and life-saver like improved and expanded 'Medicare for All'? If they had, none of this would be happening and we’d all be looking forward to having access to affordable, humane health care with a single standard of high quality care on New Years Day.

That would have been a true holiday gift, not this “Bah Humbug” we are about to receive.

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